框架立体定向图像引导颈椎弓根螺钉个体化置钉的实验研究

Experimental study of frame-stereotactic image-guided individual cervical pedicle screws placement

目的探索一种基于虚拟现实可视化技术的颈椎弓根螺钉置钉方法。方法选取6例成人颅-颈椎标本，改进的四柱式定位框架以螺钉固定于枕颈部，使颅-颈-肩形成统一刚性结构，保持空间位置恒定。CT薄层扫描获取60个椎弓根的空间定位数据，Aero—tech手术规划系统三维建模，设计安全、个体化的置钉路径，导向弓把持下经皮细钻钻孔，套管针导引下置入攻丝，复查CT评价置钉的准确性。结果60个椎弓根置钉中，攻丝与规划路径有偏差者8个，失败率为13％，横突孔方向突破5个，椎管骨皮质突破3个；6例位于C（3-5）（占75％）；2例位于C1、C2椎体（占25％）。结论框架立体定向图像引导的颈椎弓根螺钉个体化置入方向精确，减少置钉的并发症，置钉过程直观、简单，能术前虚拟演示，有临床应用前景。

Objective To investigate a new methods of individual cervical pedicle screws placement being based upon virtual reality-scientific visualization technique （ imaging being syncretlzed and intersected virtual path maneuvering and real time navigation ）. Methods 6 adult cranio-cervlcal cadavers, Ameliorated four-column stereotactic frame was installed on occlpital-cervical with screws, Made craniocervical-scapular to shape uniform rigid body, Kept spaclal position stable, Thin-sllce CT scan acquired spaeial position data of 60 cervical pedlele. Aero-teeh surgical plan software assisted construction of threedimension model. Designed the safe ,individual inserting path, Guide-arch hold the accurate direction to drill percutaneously, Trocar guided inserting guidewire, CT-countercheck assessed placement veracity. Results 8 Inserting appeared divergence of guide wire and plan path （ 13% ）. Breaches of transverse foramen was five, breaches of spinal canal was three. The departure located at C3 - C5 segment represented 75%. Conclusion Frame-stereotactlc image-gulded individual cervical pedlcle screws placement ensures the accurate direction, reduces surgical complication. Inserting path was simplified, intuitlonistlc and virtual maneuvering. Perspective of clinical application was better.